A white coat is more than just a symbol

The raging controversy over whether doctors should wear white coats has been based on the theoretical problem of possibly infecting patients with organisms that can be cultured from white coats vs. the lack of an apparent benefit from wearing a white coat.

A 2012 paper by investigators from Northwestern University in the Journal of Experimental Social Psychology sheds some new light on the latter issue.

Rather than summarizing the study myself, I will quote the excellent New York Times article about the three experiments that were done [emphasis added by me]:

In the first experiment, 58 undergraduates were randomly assigned to wear a white lab coat or street clothes. Then they were given a test for selective attention based on their ability to notice incongruities, as when the word “red” appears in the color green. Those who wore the white lab coats made about half as many errors on incongruent trials as those who wore regular clothes.

Does wearing jackets over scrub suits prevent infections?

I always enjoy papers that reinforce my biases. Here’s one called “The Impact of Perioperative Warm-up Jackets on Surgical Site Infection: Cost without Benefit?”

If you’re a regular reader of my blog, you undoubtedly know the answer. Wearing jackets over scrub suits doesn’t prevent infections and adds costs.

Investigators from the University of Minnesota looked at infection rates one year before the institution of a mandatory warm-up jacket over scrub suit policy and one year after.

The rate of surgical site infection for the 13,302 cases done in the year before jackets had to be worn was 2.42% compared to 2.67% for the 12,998 cases done during the year after. The difference was not statistically significant with a p value of 0.1998.

Why I wear a white coat

A recent article in a major newspaper asked why physicians still wear white coats. The theme echoed many recent stories of bacterial contamination of clothing and other inanimate objects. [For more on this subject, click on the "Infection" label on the right next to this post.] 

It also brought to mind a controversial rule instituted by the UK’s National Health Service in 2008 that all medical and nursing staff could not wear ties or white coats and had to have arms “bare below the elbow.”

Despite published papers reporting the existence of bacteria on white coats and ties, the UK policy was not based on any evidence linking coats, ties or long sleeves to transmission of infection to patients.

The subject has been debated for years. Yes, the white coat may be contaminated with bacteria. But whatever one wears may also be contaminated. What is the difference between wearing a white coat for few days and wearing a suit jacket or a pair of pants for a few days?

I wear a white coat for the following reasons:

• It has a lot of pockets
• It protects my clothes from blood, vomit, pus and poop.
• It is easy to clean.
• It is laundered by my hospital.

I change it at regular intervals, usually amounting to fewer than 5 days. I doubt very much that doctors who don’t wear white coats have their suits, sport coats or pants dry cleaned that frequently.

Taking advantage of the adverse publicity about ties, I have stopped wearing them because it’s more comfortable rather than for an unsupported notion of an infection risk for patients.

More importantly, I wash my hands or use a gel quite often.

Do you wear a white coat? Why or why not?

A version of this was posted on Sermo yesterday. A majority of those few who commented say they do still wear white coats.